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Frau, 35 J., seit ca. 2 Jahren kolikartige Schmerzen im Unterbauch,
Durchfall, Meteorismus, erhöhte Blutsenkungsreaktion. Operationspräparat
- Segmentale Verdickung und Entzündung der ganzen Wand des Ileum
mit Lymphfollikelbildung und tuberkuloiden
Granulomen (werden in 50 - 70% gefunden)
- Hyperämie, Ödem, tiefe,
spaltförmige Ulcera (Ulzeration)
- Oft bis in die Lamina muscularis propria reichende, herdförmige
Fibrose der Tunica mucosa und submucosa. Infiltrate von Lymphozyten,
Plasmazellen, Histiozyten, weniger von neutrophilen und eosinophilen
Granulozyten
- Starke Verdickung und herdförmige Fibrose sowie entzündliche
Infiltrate der Tunica muscularis propria
- Oedem, entzündliche Infiltrate,
Fibrose der Tunica subserosa
- Granulome in gesamter Wand und regionären Lymphknoten lokalisiert.
Aufbau: Lose angeordnete Makrophagen, Riesenzellen
vom Langhanstyp
Wichtig: Transmurale Entzündung, Fibrose, tuberkuloide Granulome
35-year-old female suffered from cramping abdominal pain, diarrhoea and flatulence since about 2 years.
Her erythrocyte sedimentation rate was increased. (Specimen from surgical resection).
- Segmental thickening and inflammation of entire wall of ileum with presence of lymph follicles (Lymphfollikelbildung) and tuberculoid granulomas (present in 50-70% of cases).
- Mucosa demonstrates multiple ulcers, some of which deeply penetrate the mucosa in a slit-like fashion.
- In between ulcers (Ulzeration), the mucosa is oedematous (Ödem); some of the villi are flattened and broad.
- The lamina propria exhibits an increased inflammatory infiltrate consisting mainly of lymphocytes and plasma cells. The inflammatory infiltrate
extends into the submucosa, with formation of lymphoid aggregates. The latter can also be seen in the subserosa (transmural inflammation).
- The submucosa exhibits considerable fibrosis.
The transmural inflammation with formation of lymphoid aggregates, the fibrosis of the submucosa and occasional granulomas are hallmarks of
Crohn's disease. Granulomas are observed in 50-70% of cases. They are poorly formed and consist of loose aggregates of epitheloid cells
with occasional Langhans giant cells (Riesenzellen). Granulomas are missing in this biopsy specimen.